Provider Demographics
NPI:1811358310
Name:AMMON, GWENDOLYN
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:AMMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 N WALL ST
Mailing Address - Street 2:#2
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5021
Mailing Address - Country:US
Mailing Address - Phone:509-362-3137
Mailing Address - Fax:
Practice Address - Street 1:3910 N WALL ST
Practice Address - Street 2:#2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-5021
Practice Address - Country:US
Practice Address - Phone:509-362-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist